Hunt & Hampson, 1980b
Dept. of Psychiatry and Behavioral Sciences, Gender Dysphoria Clinic, University of Washington, Seattle, WA, USA

This publication reports about methodologically clearly structured research. A patient group that had received at the same institution a widely unified treatment was analyzed with a standardized data gathering instrument (Hunt & Hampson, 1980a). The evaluation is done by two researchers independent of one another, one of whom participated in the treatment. The result representation is hardly clear because it mostly limits itself to the sharing of measuring values.

• Sample
• Study Methods
• Evaluation Fields and Criteria
• Results
• Suicide Attempts/Role Re-reversal
• Follow-up Studies Mentioned
• Authors' Conclusion
• Indication Recommendations
• Remarks

Study Methods
The primary author, who was a member of the previous selection team, maintained a year-long direct contact either in writing or by telephone with most of the patients. The secondary author was, presumably, an independent evaluator. Both authors had one to three-hour long interviews with 13 of the 17 females; 11 interviews were done in the presence of both researchers, two by just one researcher. These two conversations were protocoled on tape and later evaluated by the other researcher. With the four females who could not come to interviews due to the distance involved, in the course of one year, at least five phone calls were made. Additional information about patients was gathered from family members or others who had close contact to patients. Based on this information, all 17 females were evaluated by a standardized rating scale (Hunt & Hampson, 1980a). Additionally patients did a series of psycho-diagnostic questionnaires (MMPI, WAIS, Reitan Battery, Interpersonal Discrimination Task). Data for the pre-surgical situation was compiled by the primary author retrospectively by means of clinic files.

Evaluation Fields and Criteria
Through a standardized four-step rating scale published in the annex of the publication, the following areas were evaluated by the authors: Stability of employment; financial independence; stability of social contacts; satisfaction with social contacts; current support system; psycho-pathological conspicuosness; drug abuse; legal problems; gender identity; choice of sex partner; function of the vagina; sexual satisfaction; additional cosmetic procedures; present reaction of the family.

Results
For each female the results are given in the form of total scores measured for the situation at the time of the follow-up study. Of a maximum 45 points possible, three females had 40 or more, 11 had 30 or more, two more than 20 and one 16. The mean is 33.9.
Besides this, pre- and post-surgical characteristics are compared in five areas. The economic adjustment (maximum score of 6) improved as mean from 3.2 to 4.5; three patients worsened in this area. The interpersonal relationships (maximum score of 9) improved as a mean from 5.2 to 6.8; for five females a worsening was observed. The average score for psychopathologic characteristics (6.7; maximum value of 9) was unchanged; four females had a worsening in this area. The sexual adjustment (maximum score of 3) improved in the mean from 1.0 to 2.2; only one female had a slight worsening. Also there was a worsening in the reaction of the family; as a mean the score improved for patients in this area from 0.7 to 1.7 (maximum score of 3). Twenty-four percent of the females had a ">driven< need for further surgical procedures similar to that seen in precastration applicants" (p. 436). All results are ordered by areas, represented in tabular form. Clinical details or individual courses are not shared.

Suicide Attempts/Role Re-reversal
Two females had attempted suicide - one year after surgery for one, and for the other six years after surgery. In both cases the authors saw no connection to the gender reassignment but with actual partnership conflicts. The pre-surgical suicidal tendencies are not quantified. It is only said that "in fact many enthusiastically volunteered that the changes were responsible for their being alive at the time of follow-up" (p. 435).
None of the females expressed the desire to revert back into the former role. To the contrary of the subjective judgement of the females, the authors seriously doubted that some of the females felt like females.

Follow-up Studies Mentioned
Benjamin, 1966; Hastings, 1974; Hertz et al., 1961; Hoenig et al., 1971; Hore et al., 1975; Meyer & Reter, 1979; Money & Ehrhardt, 1970; Pauly, 1968; Randell, 1969; Stürup, 1976; Wålinder & Thuwe, 1975

Authors' Conclusion
The authors consider the follow-up study period sufficiently long to achieve conclusions about the effectiveness of treatment by the results. "Although the group was quite diverse, it would appear that on the whole they fared well" (p. 435).
Regarding psychodiagnostic testing, they remarked that changes of psychopathology, in as far as they were measurable by the testing methods employed, could not be objectivized. They did not find an affirmation of the hypothesis that patients who, measured by the employed psychodiagnostic testing methods, were found to be more differentiated would profit more from the treatment than the non-differentiated ones.

Indication Recommendations
Regarding the prognosis, and thereby also the indication, the authors see the best predicator in a successful pre-surgical life in the other gender's role. At the same time, they say that the indication for hormonal and sex reassignment should not be done automatically after a successful Real-Life-Test. Additionally, the "presurgical ego strength" (p. 436) must be considered. For the rest, the indication recommendations correspond to the admittance criteria (see above) in the treatment program.

Remarks
It is to be viewed critically that information about the type of treatment applied is missing. This is valid for the psychiatric or psychotherapeutic treatments as well as for the hormone treatment and each of the surgical interventions. Regarding the representation of results, it would be desirable that something would have been shared above the global scores, something about the post-surgical state of the females, especially because in the areas differentiated information was compiled.